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214 Errors in Medication Prescriptions in Paediatric Intensive Care Patients
  1. B Maat1,
  2. CW Bollen2,
  3. AJ van Vught2,
  4. ACG Egberts1,3,
  5. CMA Rademaker1
  1. 1Department of Clinical Pharmacy, University Medical Center Utrecht
  2. 2Department of Pediatric Intensive Care, Wilhelmina Children’s Hospital, University Medical Center Utrecht
  3. 3Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands

Abstract

Background and aims Prescribing errors frequently occur in paediatric medicine, especially in paediatric intensive care units (PICUs). Computerized physician order entry (CPOE) systems may help to prevent these errors. This study examined the frequency, nature and determinants of prescribing errors in electronic and handwritten prescriptions in a PICU population.

Methods All prescriptions (electronic and handwritten) for children aged 0–18 years hospitalized in a 14-bed PICU of a university medical center, The Netherlands, from February 2008 - December 2010, were prospectively collected and checked for prescribing errors and determinants (prescription-, patient- and medication-related) thereof.

Results 23,207 prescriptions for 659 patients were collected, of which 14,887 (64%) were handwritten and 8,312 (36%) electronically ordered. 6% of the prescriptions contained a therapeutic error and 54% was administratively incomplete (1–7 missing items per prescription). Electronically ordered prescriptions contained significantly less therapeutic and administrative errors than handwritten prescriptions (p<0.001), mainly due to better legibility and completeness. More than 10% of the prescribed doses was outside the therapeutic range of the Dutch paediatric drug formulary. Important determinants of prescribing errors were handwritten prescriptions (OR=3.1 [2.9–3.3]), intravenous medication (OR=2.9 [2.6–3.3]), the youngest of age (up to 1 month OR=1.2 [1.1–1.4] and drugs affecting the musculo-skeletal system (OR=3.4 [2.9–3.9]).

Conclusions PICU prescribing errors occur frequently. CPOE systems reduce error rates but do not fully prevent these. Data to support what is exactly needed to build better prescribing systems for PICU patients are scarce. This study provides information for improvements in electronic prescribing for PICU patients.

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